Claimant Maria Lopez ("Lopez" or "claimant") filed this action seeking review of the final decision of the Commissioner of Social Security (the "Commissioner"), denying Lopez's claim for disability insurance benefits ("DIB") under the Social Security Act ("the Act"), 42 U.S.C. §§ 416(i) and 423(d). This Court has jurisdiction to hear this matter pursuant to 42 U.S.C. § 405(g), and the parties have consented to the jurisdiction of the United States Magistrate Judge, pursuant to 28 U.S.C. § 636(c). Lopez and the Commissioner have each filed a cross-motion for summary judgment [21, 26]. For the reasons set forth below, Lopez's motion for summary judgment [26] is granted in part and denied in part, the Commissioner's motion for summary judgment [21] is denied, and the case is remanded for further proceedings consistent with this Opinion.

I. BACKGROUND

A. Procedural History

Lopez applied for DIB on August 26, 2009, alleging that she became disabled on March 6, 2009 due to chronic hepatitis, type II diabetes, high blood pressure and esophageal problems. (R. 66.) After filing her initial application, she began seeking treatment for depression and this was added to her claim for DIB. (R. 31.) Her application was denied on November 17, 2009, and upon reconsideration on April 14, 2010. (R. 67, 72.) Lopez requested a hearing on May 26, 2010, which was held before Administrative Law Judge Janice Bruning (the "ALJ") on April 6, 2011. (R. 39-60.) Lopez and a Vocational Expert testified at the hearing. ( Id. ) On June 7, 2011, the ALJ denied Lopez's request for DIB. (R. 23-32.) Lopez then sought review of the ALJ's decision, but the Appeals Council denied review on July 6, 2012. (R. 1.) She now seeks judicial review of the ALJ's decision, which stands as the final decision of the Commissioner. Villano v. Astrue, 556 F.3d 558, 561-62 (7th Cir. 2009).

B. Medical Evidence

1. Dr. Archana Goel

Lopez began seeing her primary care physician, Dr. Archana Goel, on April 19, 1999. (R. 332.) Since that date, she has seen Dr. Goel approximately five times per year. ( Id. ) Dr. Goel diagnosed Lopez with autoimmune hepatitis, cirrhosis of the liver, type II diabetes, esophageal varices, osteoporosis, hypertension, and autoimmune thrombocytopenia. ( Id. ) While many of Dr. Goel's treatment notes are illegible, it is clear that Lopez saw Dr. Goel regularly for her diabetes. (R. 265-69, 314-18.) These treatment notes indicate that at times, Lopez stated that she was not watching her diet, and she was not taking all of her prescribed medication. (R. 266.) These notes also reveal that Lopez occasionally reported having low energy and fatigue. (R. 265, 314-15.)

On January 13, 2010, Dr. Goel completed a Physical Residual Functional Capacity Questionnaire, in which she stated that Lopez's prognosis was fair, and her symptoms included chronic fatigue and bruising easily. (R. 332.) According to the questionnaire, Lopez was not experiencing any pain. ( Id. ) Dr. Goel also indicated that Lopez's medication caused fatigue, but that her pain and other symptoms were only rarely severe enough to interfere with the attention and concentration necessary to perform simple tasks. (R. 333.) Dr. Goel also stated that Lopez can only walk two blocks without resting, she can sit for more than two hours at a time, and she can stand for one hour at a time. ( Id. ) Dr. Goal also opined that in an eight hour workday, Lopez can sit for four hours, stand or walk for less than two hours, and she would need to take unscheduled, fifteen-minute breaks every ninety minutes. (R. 332-34.) Dr. Goal concluded that Lopez would likely have "good days" and "bad days" and she would be absent from work more than four days per month. (R. 334.)

2. Dr. Deepak Khurana

Lopez was also treated by Dr. Deepak Khurana, a gastroenterologist. On March 7, 2009, Dr. Khurana performed an ultrasound of Lopez's liver, which revealed cirrhosis of the liver with no ascites present. (R. 234.) Dr. Khurana noted that there was evidence of gallstones, possible kidney stones, and bidirectional flow in the main portal vein, and these findings were consistent with records from July of 2008. ( Id. ) At an appointment later that month, Lopez stated she was doing well, she suffered from no cardiac, respiratory, or gastrointestinal issues and her abdomen appeared normal. (R. 242.)

On April 7, 2009, Dr. Khurana performed an esophagastroduodenoscopy (an "EGD"), which indicated mild gastritis with no varices. (R. 239-40.) Her stomach was normal and the esophagus showed some scarring from a previous rubber band ligation. (R. 239.) The test also showed some small superficial venules and a small sliding hiatal hernia. ( Id. ) At this time, Dr. Khurana noted that Lopez complained of mild systemic disease with no functional limitations. (R. 326.) Dr. Khurana recommended that Lopez continue with the beta blockers and undergo another EGD in one year. (R. 239.) In a follow up visit on July 8, 2009, Dr. Khurana noted that Lopez was suffering from heartburn and hypertension, but her abdomen was normal and there were no other gastrointestinal issues. (R. 241.)

Dr. Khurana examined Lopez again on June 15, 2010. (R. 371.) At that time, Lopez complained of some on and off fatigue, bloating and heartburn. ( Id. ) Dr. Khurana indicated there was no recent weight change and no other cardiovascular, genitourinary, or musculoskeletal issues. ( Id. ) Her vitals were normal and her general appearance was "well nourished" and "well developed." (R. 372.) Dr. Khurana's assessment was esophageal disorders, esophageal varices, chronic active autoimmune hepatitis, and primary biliary cirrhosis. ( Id. ) She prescribed Prednizone, Propranolol, Ursodiol and Ranitidine and recommended a follow-up visit in a few months. (R. 373.)

Dr. Khurana performed a second EGD on July 12, 2010, which showed mild esophagitis and a small hiatal hernia. (R. 350.) At this time, Dr. Khurana noted again a small sliding hiatal hernia, some erythema at the GE junction, mild gastritis and a small benign nodule in her stomach. (R. 350-51.) Otherwise, there were no varices or abnormalities in the stomach or esophagus. ( Id. ) A subsequent biopsy of the stomach nodule showed gastric mucosa with mild to moderate chronic inflammation, and the GU junction biopsy revealed gastroesophageal junction mucosa with moderate acute and chronic inflamation. (R. 352.)

On November 9, 2010, Dr. Khurana examined Lopez prior to a trip she was taking to Puerto Rico. (R. 368.) Dr. Khurana noted no malaise, no fever and no recent weight change. ( Id. ) She indicated that there were no cardiovascular, gastrointestinal, genitourinary, or musculoskeletal issues. (Id. ) At the time, Lopez was taking the following medications: Boniva, calcium tablets, Lantus, Lininopril, Prednizone, Ranitidine, and potassium tablets. ( Id. ) Her vitals were normal and her general appearance was "well developed" and "well nourished." (R. 369.) Dr. Khurana's assessment was esophageal varices, PBC/AIH overlap syndrome, and autoimmune hepatitis. ( Id. ) On November 19, 2010, Dr. Khurana performed an ultrasound of Lopez's abdomen, which revealed that her gallbladder had an abnormal appearance and the wall was thickened, and there was a gallstone present. (R. 345.)

There is no evidence of any mood disorders, depression or anxiety in any of Dr. Khurana's treatment notes. Nevertheless, Dr. Khurana completed a mental impairment questionnaire for Lopez on November 22, 2010, noting that, in addition to her physical impairments, Lopez suffered from major depression. (R. 340.) Dr. Khurana assigned Lopez a GAF score of 50. ( Id. ) Dr. Khurana stated that, as a result of her depression, Lopez suffered from poor memory, appetite disturbance with weight change, sleep disturbance, mood disturbance, anhedonia or pervasive loss of interests, feelings of guilt/worthlessness, difficulty thinking or concentrating, social withdrawal or isolation, decreased energy, persistent irrational fears and generalized persistent anxiety. ( Id. ) Dr. Khurana did not indicate that Lopez's depression caused delusions or hallucinations but found her mood to be sad and anxious, and that she had low concentration. (R. 340-41.) She also noted that Lopez was taking Lexapro for her depression, which may affect her ability to work because it caused fatigue. (R. 341.) She stated that Lopez's impairment lasted or could be expected to last longer than twelve months, and that the depression would cause Lopez to be absent from work more than three times a month. ( Id. )

Additionally, Dr. Khurana indicated that Lopez has a "poor" ability to perform the following tasks: maintain attention for two-hour segments, maintain regular attendance and be punctual, work in coordination or proximity to others without distraction, complete a normal workday or workweek without interruptions from her mental impairment, perform at a consistent pace without taking a number of breaks, respond appropriately to changes in her routine work setting, and deal with normal stress. (R. 342.) Dr. Khurana attributed these impairments to Lopez's depression, low concentration, anxiety, and poor stress tolerance. (R. 343.) Dr. Khurana opined that Lopez's capabilities are "good" with respect to the following work tasks: remembering work-like procedures, understanding, remembering and carrying out very short and simple instructions, sustaining an ordinary routine without special supervision, making simple work-related decisions, asking simple questions or requesting assistance, accepting instructions and responding appropriately to criticism from supervisors, getting along with co-workers, and taking appropriate precautions around normal hazards. (R. 342.)

Dr. Khurana indicated the extent to which these functional areas are affected by Lopez's mental impairments. (R. 343.) Dr. Khurana found that Lopez's depression only "slightly" restricts her daily activities, its effect on her social functioning is "marked, " and its effect on her concentration, persistence, or pace is "frequent." ( Id. ) In addition, Dr. Khurana opined that Lopez's depression would lead to repeated episodes of decompensation in a work-like setting that would cause her to withdraw or experience exacerbated signs and symptoms. (R. 342.)

3. Dr. Eva Kurilo

Psychologist Dr. Eva Kurilo treated Lopez for depression beginning on February 28, 2010. (R. 363.) Dr. Kurilo diagnosed Lopez with major depression, single episode, and assigned her a GAF score of 60. (R. 364.) At this appointment, Lopez's mood was sad, her affect mood congruent, and she was tearful on a few occasions but smiling appropriately during the interview. ( Id. ) Dr. Kurilo also noted that Lopez's attention was good and her concentration and insight were fair. ( Id. ) Dr. Kurilo reported that Lopez denied any history of voices, visions or paranoia. (R. 363.) Lopez stated that she had been having problems with depression for the last few years, but her depression has become more problematic recently because she is having issues with her husband, who wants to return Puerto Rico, and she would like to stay here. ( Id. ) She was not previously treated for depression. ( Id. ) Lopez stated that her symptoms include: crying spells, anxiety, concentration problems, lack of energy, sleeping too much, and periods of helplessness and hopelessness. ( Id. ) Dr. Kurilo wanted to begin Lopez's ...

Our website includes the first part of the main text of the court's opinion.
To read the entire case, you must purchase the decision for download. With purchase,
you also receive any available docket numbers, case citations or footnotes, dissents
and concurrences that accompany the decision.
Docket numbers and/or citations allow you to research a case further or to use a case in a
legal proceeding. Footnotes (if any) include details of the court's decision. If the document contains a simple affirmation or denial without discussion,
there may not be additional text.

Buy This Entire Record For
$7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.